NUR 114 EXAM 3 COMPREHENSIVE STUDY GUIDE
NCLEX-Style Questions with Verified Answers,
Rationales & Test-Taking Strategies
Jefferson State Community College / Forsyth
Technical Community College | Latest 2026 Update
SECTION 1: RENAL & URINARY DISORDERS
1. A 71-year-old patient with benign prostatic hyperplasia (BPH) and urinary
retention is admitted with elevated BUN and creatinine. Which prescribed therapy
should the nurse implement first?
A. Infuse normal saline at 50 mL/hr.
B. Insert a urinary retention catheter.
C. Draw blood for a complete blood count.
D. Schedule a pelvic CT scan.
Answer: B
Rationale: The elevated BUN and creatinine indicate postrenal acute kidney injury
caused by urinary retention from BPH. The priority is to relieve the obstruction
with a urinary catheter to restore urine flow and prevent further kidney damage.
,Test-Taking Strategy: Use the ABCs + Safety framework. In postrenal AKI, the
priority is relieving the obstruction before other interventions.
2. The nurse cares for a client diagnosed with Acute Kidney Injury (AKI). A MAP of
what value indicates the kidneys are NOT being adequately perfused?
A. < 120 mmHg
B. < 90 mmHg
C. < 75 mmHg
D. < 65 mmHg
Answer: D
Rationale: A MAP (Mean Arterial Pressure) < 65 mmHg indicates inadequate renal
perfusion. Adequate MAP is required to maintain blood flow to the kidneys and
prevent ischemic injury.
Test-Taking Strategy: The normal MAP is 70-100 mmHg. The threshold for
adequate organ perfusion is typically 60-65 mmHg.
3. The nurse is reviewing the phases of Acute Kidney Injury (AKI). Match each
phase with its description:
Phase Description
1. Oliguric A. Kidney tries to push fluid through; urine becomes more dilute
, 2. Diuretic B. Kidney is recovering; GFR increases toward normal
3. Recovery C. Kidneys are insulted; dark urine, increased BUN & creatinine
Answer: 1-C, 2-A, 3-B
Rationale:
Oliguric Phase: Kidneys are insulted. Expected findings: cloudy, dark urine,
increased BUN & creatinine, decreased specific gravity, decreased GFR.
Diuretic Phase: Kidney tries to push fluid through. Expected: more dilute urine,
gradual decrease in BUN & creatinine.
Recovery Phase: Kidney is recovering. Expected: increased GFR, stabilization of
BUN & creatinine toward normal.
4. A patient is receiving hemodialysis. Which access device is considered
permanent and requires 6 weeks to mature before use?
A. Subclavian vein catheter
B. Femoral vein catheter
C. Arteriovenous (AV) fistula
D. Tunneled central line
Answer: C
NCLEX-Style Questions with Verified Answers,
Rationales & Test-Taking Strategies
Jefferson State Community College / Forsyth
Technical Community College | Latest 2026 Update
SECTION 1: RENAL & URINARY DISORDERS
1. A 71-year-old patient with benign prostatic hyperplasia (BPH) and urinary
retention is admitted with elevated BUN and creatinine. Which prescribed therapy
should the nurse implement first?
A. Infuse normal saline at 50 mL/hr.
B. Insert a urinary retention catheter.
C. Draw blood for a complete blood count.
D. Schedule a pelvic CT scan.
Answer: B
Rationale: The elevated BUN and creatinine indicate postrenal acute kidney injury
caused by urinary retention from BPH. The priority is to relieve the obstruction
with a urinary catheter to restore urine flow and prevent further kidney damage.
,Test-Taking Strategy: Use the ABCs + Safety framework. In postrenal AKI, the
priority is relieving the obstruction before other interventions.
2. The nurse cares for a client diagnosed with Acute Kidney Injury (AKI). A MAP of
what value indicates the kidneys are NOT being adequately perfused?
A. < 120 mmHg
B. < 90 mmHg
C. < 75 mmHg
D. < 65 mmHg
Answer: D
Rationale: A MAP (Mean Arterial Pressure) < 65 mmHg indicates inadequate renal
perfusion. Adequate MAP is required to maintain blood flow to the kidneys and
prevent ischemic injury.
Test-Taking Strategy: The normal MAP is 70-100 mmHg. The threshold for
adequate organ perfusion is typically 60-65 mmHg.
3. The nurse is reviewing the phases of Acute Kidney Injury (AKI). Match each
phase with its description:
Phase Description
1. Oliguric A. Kidney tries to push fluid through; urine becomes more dilute
, 2. Diuretic B. Kidney is recovering; GFR increases toward normal
3. Recovery C. Kidneys are insulted; dark urine, increased BUN & creatinine
Answer: 1-C, 2-A, 3-B
Rationale:
Oliguric Phase: Kidneys are insulted. Expected findings: cloudy, dark urine,
increased BUN & creatinine, decreased specific gravity, decreased GFR.
Diuretic Phase: Kidney tries to push fluid through. Expected: more dilute urine,
gradual decrease in BUN & creatinine.
Recovery Phase: Kidney is recovering. Expected: increased GFR, stabilization of
BUN & creatinine toward normal.
4. A patient is receiving hemodialysis. Which access device is considered
permanent and requires 6 weeks to mature before use?
A. Subclavian vein catheter
B. Femoral vein catheter
C. Arteriovenous (AV) fistula
D. Tunneled central line
Answer: C
